Cognitive Science, Volume 46, Issue 10, October 2022.

Despite the challenges associated with virtually mediated communication, remote collaboration is a defining characteristic of online multiplayer gaming communities. Inspired by the teamwork exhibited by players in first-person shooter games, this study investigated the verbal and behavioral coordination of four-player teams playing a cooperative online video game. The game, Desert Herding, involved teams consisting of three ground players and one drone operator tasked to locate, corral, and contain evasive robot agents scattered across a large desert environment. Ground players could move (...) throughout the environment, while the drone operator’s role was akin to that of a “spectator” with a bird’s-eye view, with access to veridical information of the locations of teammates and the to-be-corralled agents. Categorical recurrence quantification analysis was used to measure the communication dynamics of teams as they completed the task. Demands on coordination were manipulated by varying the ground players’ ability to observe the environment with the use of game “fog.” Results show that catRQA was sensitive to changes to task visibility, with reductions in task visibility reorganizing how participants conversed during the game to maintain team situation awareness. The results are discussed in the context of future work that can address how team coordination can be augmented with the inclusion of artificial agents, as synthetic teammates. (shrink)

We offer a novel account of metalinguistic comparatives, such as 'Al is more wise than clever'. On our view, metalinguistic comparatives express comparative commitments to conventions. Thus, 'Al is more wise than clever' expresses that the speaker has a stronger commitment to a convention on which Al is wise than to a convention on which she is clever. This view avoids problems facing previous approaches to metalinguistic comparatives. It also fits within a broader framework—independently motivated by metalinguistic negotiations and convention-shiftingexpressions— (...) that gives linguistic conventions a role in the semantics. (shrink)

Friesen et al. (2023) describe barriers to research in patient populations that have been historically labeled as vulnerable and, as a result, are under-represented in research due to the Instituti...

We give a brief overview of several recent strands of speech-act theory, and then survey some issues in social and political philosophy can be profitably understood in speech-act-theoretic terms. Our topics include the social contract, the law, the creation and reinforcement of social norms and practices, silencing, and freedom of speech.

Observational learning can enhance the acquisition and performance quality of complex motor skills. While an extensive body of research has focused on the benefits of synchronous (i.e., concurrent physical practice) and non-synchronous (i.e., delayed physical practice) observational learning strategies, the question remains as to whether these approaches differentially influence performance outcomes. Accordingly, we investigate the differential outcomes of synchronous and non-synchronous observational training contexts using a novel dance sequence. Using multidimensional cross-recurrence quantification analysis, movement time-series were recorded for novice dancers (...) who either synchronised with (n = 22) or observed and then imitated (n = 20) an expert dancer. Participants performed a 16-count choreographed dance sequence for 20 trials assisted by the expert, followed by one final, unassisted performance trial. Although end-state performance did not significantly differ between synchronous and non-synchronous learners, a significant decline in performance quality from imitation to independent replication was shown for synchronous learners. A non-significant positive trend in performance accuracy was shown for non-synchronous learners. For all participants, better imitative performance across training trials led to better end-state performance, but only for the accuracy (and not timing) of movement reproduction. Collectively, the results suggest that synchronous learners came to rely on a realtime mapping process between visual input from the expert and their own visual and proprioceptive intrinsic feedback, to the detriment of learning. Thus, the act of synchronising alone does not ensure an appropriate training context for advanced sequence learning. (shrink)

The comorbidity of chronic pain and opioid addiction is a serious problem that has been growing with the practice of prescribing opioids for chronic pain. Neuroimaging research has shown that chronic pain and opioid dependence both affect brain structure and function, but this is the first study to evaluate the neurophysiological alterations in patients with comorbid chronic pain and addiction. Eighteen participants with chronic low back pain and opioid addiction were compared with eighteen age- and sex-matched healthy individuals in a (...) pain-induction fMRI task. Unified structural equation modeling (SEM) with Lagrange multiplier (LM) testing yielded a network model of pain processing for patient and control groups based on 19 a priori defined regions. Tests of differences between groups on specific regression parameters were determined on a path-by-path basis using z-tests corrected for the number of comparisons. Patients with the chronic pain and addiction comorbidity had increased connection strengths; many of these connections were interhemispheric and spanned regions involved in sensory, affective, and cognitive processes. The affected regions included those that are commonly altered in chronic pain or addiction alone, indicating that this comorbidity manifests with neurological symptoms of both disorders. Understanding the neural mechanisms involved in the comorbidity is crucial to finding a comprehensive treatment, rather than treating the symptoms individually. (shrink)

Being open to persuasion can help show respect for an interlocutor. At the same time, open-mindedness about morally objectionable claims can carry moral as well as epistemic risks. Our aim in this paper is to specify when there might be duty to be open to persuasion. We distinguish two possible interpretations of openness. First, openness might refer to a kind of mental state, wherein one is willing to revise or abandon present beliefs. Second, it might refer to a deliberative practice, (...) according to which one is willing to engage with opposing reasons. We suggest these two interpretations are conceptually and empirically distinct. Once disambiguated, we suggest that different contexts may make different forms of openness appropriate as expressions of respect. (shrink)

Conventional wisdom has it that truth is always evaluated using our actual linguistic conventions, even when considering counterfactual scenarios in which different conventions are adopted. This principle has been invoked in a number of philosophical arguments, including Kripke’s defense of the necessity of identity and Lewy’s objection to modal conventionalism. But it is false. It fails in the presence of what Einheuser (2006) calls c-monsters, or convention-shifting expressions (on analogy with Kaplan’s monsters, or context-shifting expressions). We show that c-monsters naturally (...) arise in contexts, such as metalinguistic negotiations, where speakers entertain alternative conventions. We develop an expressivist theory—inspired by Barker (2002) and MacFarlane (2016) on vague predications and Einheuser (2006) on counterconventionals—to model these shifts in convention. Using this framework, we reassess the philosophical arguments that invoked the conventional wisdom. (shrink)

PurposeThe purpose of this paper is to examine the impact of the digital culture on football supporters through analysis of official and unofficial websites and media reports. At first glance it would appear that technology has brought about greater opportunities to communicate, to share views which previously could not be widely published, and to organise against the commercial power of the large football clubs. However, surveillance, censorship and control continue to impact on supporters to restrict and ultimately prevent the ideal (...) speech situation that is necessary to empower fans and promote greater participation in their clubs. Current media manipulation and corporate interests restrict and alienate fans who often have more of a historically constituted sense of ownership and culture within their local clubs.Design/methodology/approachA critical social theory approach is adopted to examine structures and processes related to communication between fans, the media, football clubs and the public. Habermas' theory is draw upon using the concepts of “colonization of the Lifeworld” and “communicative action” to inform a theme and discourse analysis of official and independent football club websites and media reports. How corporate interests are manipulating public opinion and freedom to speak openly within an overall goal of profit maximization for club owners and the large media corporations are explored.FindingsAlthough steps to enable free communication have been made we are still a long way off supporters having a powerful enough voice to organise against the commercial power of the large football clubs and media conglomerates. The ideal speech situation remains elusive and the hegemonic state remains unchallenged. Football supporters are increasingly constructed as “consumers” and the ultimate power remains in mass media and broadcast rather than personal “narrowcast”.Originality/valueThis paper extends debate on the impact of the developing “digital culture” focusing on football supporters, a specific and prevalent community within British society. It raises issues for further research in this area. (shrink)

Through theoretical discussion, literature review, and a computational model, this paper poses a challenge to the notion that perspective-taking involves a fixed architecture in which particular processes have priority. For example, considerable work has shown that egocentric perspectives can arise more quickly, with other perspectives (such as of task partners) emerging only secondarily. This theoretical dichotomy is challenged here, and we propose a general view of perspective-taking as an emergent phenomenon governed by the interplay among several cognitive mechanisms. We first (...) describe the pervasive relevance of perspective-taking to cognitive science. A dynamical systems model is then introduced which explicitly formulates the timescale interaction proposed. Implications are discussed, with ideas for future empirical research. (shrink)

Visual working memory is a construct hypothesized to store a small amount of accurate perceptual information that can be brought to bear on a task. Much research concerns the construct's capacity and the precision of the information stored. Two prominent theories of VWM representation have emerged: slot-based and continuous-resource mechanisms. Prior modeling work suggests that a continuous resource that varies over trials with variable capacity and a potential to make localization errors best accounts for the empirical data. Questions remain regarding (...) the variability in VWM capacity and precision. Using a novel eye-tracking paradigm, we demonstrate that VWM facilitates search and exhibits effects of fixation frequency and recency, particularly for prior targets. Whereas slot-based memory models cannot account for the human data, a novel continuous-resource model does capture the behavioral and eye tracking data, and identifies the relevant resource as item activation. (shrink)

Plato’s Socrates holds that we always have reason to be just, since being just is essential for living a happy and successful life. In Book II of Plato’s Republic, Socrates’ main interlocutor, Glaucon, raises a vivid and powerful challenge to this claim. He presents the case of Gyges, a Lydian shepherd who possesses a ring that gives him the power of invisibility. Glaucon’s contention is that Gyges does not have reason to be just in this circumstance, since being just will (...) not promote his happiness. Thus, the argument poses the following challenge: what reason do we have to be just, particularly in circumstances where we can get away with injustice? In this essay, we describe Glaucon’s challenge, highlight its similarity to challenges offered by other skeptical figures in the history of philosophy, namely, Hobbes’ Foole and Hume’s sensible knave, and present three broad lines of response. (shrink)

Two experiments, using a mock legal case, confirmed the causal role of arguments in verdict decisions and explored the process involved. Experiment 1 showed that verdicts varied with the strength of counter-arguments and Experiment 2 showed that the use of background information that undermined such arguments determined the verdict reached. Such results confirm the causal role of arguments but do not speak to the representations constructed. In both experiments we analysed the reasons proposed for verdicts. Participants generally represented the state (...) of affairs, and conjectured state of affairs, to which the arguments referred. Experiment 2 also asked participants about the number of causal possibilities they envisaged. Confidence in the verdict was moderated by the strength of counter-arguments but in different ways for those who envisaged a single causal account as opposed to two causal accounts. In the former case, confidence decreased with the rated strength of counter-arguments. In the latter case, confidence increased. We suggest that verdicts are abductive explanations of the events generated through a process of mental simulation. (shrink)

Recent EEG studies on the early postmortem interval that suggest the persistence of electrophysiological coherence and connectivity in the brain of animals and humans reinforce the need for further investigation of the relationship between the brain’s activity and the dying process. Neuroscience is now in a position to empirically evaluate the extended process of dying and, more specifically, to investigate the possibility of brain activity following the cessation of cardiac and respiratory function. Under the direction of the Center for Healthy (...) Minds at the University of Wisconsin-Madison, research was conducted in India on a postmortem meditative state cultivated by some Tibetan Buddhist practitioners in which decomposition is putatively delayed. For all healthy baseline and postmortem subjects presented here, we collected resting state electroencephalographic data, mismatch negativity, and auditory brainstem response. In this study, we present HB data to demonstrate the feasibility of a sparse electrode EEG configuration to capture well-defined ERP waveforms from living subjects under very challenging field conditions. While living subjects displayed well-defined MMN and ABR responses, no recognizable EEG waveforms were discernable in any of the tukdam cases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Full Collection of Personal NarrativesZohar Lederman, Ola Ziara, Rachel Coghlan, Oksana Sulaieva, Anna Shcherbakova, Oleksandr Dudin, Vladyslava Kachkovska, Iryna Dudchenko, Anna Kovchun, Lyudmyla Prystupa, Yuliya Nogovitsyna, Ghaiath Hussein, Kathryn Fausch, P. P. Kyaw, Ayesha Ahmad, Richard W Sams II, Handreen Mohammed Saeed, Artem Riga, Ryan C. Maves, Elizabeth Dotsenko, Irina Deyneka, Eva V. Regel, and Vita Voloshchuk• An Unsettling Affair• How We Keep Caring While Walking Through Our (...) Pain• Adjusting Laboratory Practices to the Challenges of Wartime• Why We Stay• A Semi-Personal Story from a Ukrainian NGO Professional (or a Semi-Professional Story from a Ukrainian Person) Living through the War• When Ethics Survives Where People Do Not: A Story From Darfur• Burma’s Healthcare Under Fire: My Experience as an Exiled Medical Professional• When a Conflict Collapses on a Child: An (Aborted) Medical Evacuation of a Hazara Toddler During the Kabul Airport Blast and the Taliban Takeover• The Vagaries and Vicissitudes of War• Providing Care to a Potential Aggressor: An Ethical Dilemma• One Surgeon’s Experience During Armed Conflict in Ukraine• The Limits of Our Obligations• A Liberating Breath• Soldiers of the Invisible Front: How Ukrainian Therapists Are Fighting for the Mental Health of the Nation Under Fire• Stories of Families with Chronically Ill Pediatric Patients during the War in UkraineCopyright © 2023 Johns Hopkins University Press... (shrink)

Memorialization in the form of the architectural statue can suggest that our stance towards the past is concrete while memorials in the form of repeated social activity represent reconciliation with the past as a continual process. Enacted memorials suggest that reconciliation with the past is not itself a thing of the past. Each generation must grapple with its inherited memories, guilt, and grief and self-consciously take its own stance towards that which came before it. This article considers Dominik Smole’s post (...) World War II rewrite of Antigona as an enacted memorial within the context of socialist Yugoslavia. The practice of restaging Antigona in Slovenia may be seen as the practice of meta-memorialization, which routinely returns to the past while openly weighing the dangers of awakening the unburied dead against the dangers of letting the unaddressed conflicts of the past sleep. (shrink)

The early withdrawal of students from healthcare education programmes, particularly nursing, is an international concern and, despite considerable investment, retention rates have remained stagnant. Here, a regional study of healthcare student retention is used as an example to frame the challenge of student attrition using a concept from policy development, wicked problem theory. This approach allows the consideration of student attrition as a complex problem derived from the interactions of many interrelated factors, avoiding the pitfalls of small‐scale interventions and over‐simplistic (...) assumptions of cause and effect. A conceptual framework is proposed to provide an approach to developing actions to reduce recurrent investment in interventions that have previously proved ineffective at large scale. We discuss how improvements could be achieved through integrated stakeholder involvement and acceptance of the wicked nature of attrition as a complex and ongoing problem. (shrink)

Progressive supranuclear palsy is a movement disorder with prominent tau neuropathology. Brain diseases with abnormal tau deposits are called tauopathies, the most common of which is Alzheimer's disease. Environmental causes of tauopathies include repetitive head trauma associated with some sports. To identify common genetic variation contributing to risk for tauopathies, we carried out a genome-wide association study of 1,114 individuals with PSP and 3,247 controls followed by a second stage in which we genotyped 1,051 cases and 3,560 controls for the (...) stage 1 SNPs that yielded P ≤ 10-3. We found significant previously unidentified signals associated with PSP risk at STX6, EIF2AK3 and MOBP. We confirmed two independent variants in MAPT affecting risk for PSP, one of which influences MAPT brain expression. The genes implicated encode proteins for vesicle-membrane fusion at the Golgi-endosomal interface, for the endoplasmic reticulum unfolded protein response and for a myelin structural component. © 2011 Nature America, Inc. All rights reserved. (shrink)

Indigenous Peoples, Consent and Benefit Sharing is the first in-depth account of the Hoodia bioprospecting case and use of San traditional knowledge, placing it in the global context of indigenous peoples’ rights, consent and benefit-sharing. It is unique as the first interdisciplinary analysis of consent and benefit sharing in which philosophers apply their minds to questions of justice in the Convention on Biological Diversity (CBD), lawyers interrogate the use of intellectual property rights to protect traditional knowledge, environmental scientists analyse implications (...) for national policies, anthropologists grapple with the commodification of knowledge and, uniquely, case experts from Asia, Australia and North America bring their collective expertise and experiences to bear on the San-Hoodia case. -/- While much of the focus is on bioprospecting and natural product development, Indigenous Peoples, Consent and Benefit-Sharing also draws important lessons about informed consent and benefit-sharing from the health sciences and sectors such as mining. Policymakers around the world are under significant pressure to resolve the challenges of implementing the CBD. This book’s analysis and recommendations will help them. -/- ‘It is good to see philosophers engaging with the UN Convention on Biological Diversity, and doing so by looking in depth at a real situation in which it has been invoked.’ Peter Singer, Ira W. DeCamp Professor of Bioethics in the University Center for Human Values, Princeton University . (shrink)

This paper puts Jane Bennett’s vital materialism into dialogue with Luce Irigaray’s ontology of sexuate difference. Together these thinkers challenge the image of dead or intrinsically inanimate matter that is bound up with both the instrumentalization of the earth and the disavowal of sexual difference and the maternal. In its place they seek to affirm a vital, generative materiality: an ‘active matter’ whose differential becomings no longer oppose activity to passivity, subject to object, or one body, self or entity to (...) its ‘other’. For both thinkers, displacing the hylomorphic conceptual structures that have tended to dominate western metaphysical thought is inseparable from critiquing the model of the individual subject as bounded, autonomous and self-identical. Such individualism is countered by the relational ontologies figured in Bennett’s ‘distributed agencies’ and Irigaray’s ‘placental economy’, and by a shared attentiveness to the capacities of the human body to bear others within. Nonetheless, this paper argues that each thinker renders this ‘other within’ in very different ways. On the one hand, Bennett’s approach complements and expands Irigaray’s notion of the elemental by affording a greater attentiveness to inorganic and non-sexuate matters. On the other, Irigaray’s conception of generative relationality and the ontological priority of the in-between allows us to think such material entanglements in ways that more fully displace the twinned logics of individualism and instrumentalization. Her project thereby affirms the relational and irreducible differences on which the ‘vitality’ of a vital materiality depends. If there is no more “earth” to press down/repress, to work, to represent, but also and always to desire, no opaque matter which in theory does not know herself, then what pedestal remains for the ex-sistence of the “subject”? If the earth turned and more especially turned upon herself, the erection of the subject might thereby be disconcerted and risk losing its elevation and penetration. For what would there be to rise up from and exercise his power over? And in? Irigaray, Speculum of the Other Woman Jane Bennett has recently argued that “the image of dead or thoroughly instrumentalized matter feeds human hubris and our earth-destroying fantasies of conquest and consumption”, continuing that: “The figure of an intrinsically inanimate matter may be one of the impediments to the emergence of more ecological and more materially sustainable modes of production and consumption”.11J. Bennett, Vibrant Matter: A Political Ecology of Things, Durham and London: Duke University Press, 2010, ix. Henceforth VM. View all notes This insight is prefigured and re-affirmed by the work of Irigaray. Her sustained analysis of western thought and culture shows how its constitutive disavowal of sexual difference and the maternal is inextricably bound up with an equally deep-rooted disavowal of matter and corporeality. As the above passage from Speculum suggests,22L. Irigaray, Speculum of the Other Woman, trans. G. Gill, Ithaca: Cornell University Press, 1985, 133. Henceforth S. View all notes Irigaray seeks to expose woman's reduction to an object for a subject and a maternal-material resource for man's speculations; but in disentangling woman from her symbolic identification with the earth, she also seeks to release the earth from its identification with a passive and manipulable matter. Her work thus bears directly on the revaluation required to transform human beings' relations to materiality: both their own, and that of the earth they inhabit. At the centre of this revaluation is Irigaray's work to displace the image of dead or intrinsically inanimate matter that Bennett also critiques, and to affirm instead a sexuate materiality that is both living and generative. Her consistent troubling of hylomorphism is as unsettling for the subject as her question: “But what if the ‘object’ started to speak?” This question is echoed in Bennett's concern with “the moment when the object becomes the Other, when the sardine can looks back, when the mute idol speaks”.33 VM, 2, citing W.J.T. Mitchell, What Do Pictures Want?, Chicago, Chicago University Press, 2005, 157. View all notes As this passage indicates, Bennett's own project is more concerned with the agency of non-human materialities – including their role in the constitution of the human – than with specifically sexed bodies or a materiality inflected by sexual difference. It is these crucial differences in emphasis, I will suggest, that allow the work of these two thinkers to be brought together in productive dialogue. On the one hand, Bennett's approach affords a greater attentiveness to inorganic and non-sexuate matter; on the other, Irigaray's twinned ontology of sexual difference and maternal relation is better able to affirm the relational differences on which the “vitality” of a vital materiality depends. The paper begins by outlining several key elements of Irigaray's philosophy of sexual difference to show how it leads necessarily to a rethinking of matter. This rethinking is especially helpful for shifting away from the hylomorphism that has been a dominant strand in western thought, informing an understanding of the earth as a fundamentally inert and ever-ready resource. As I will show, the figures through which Irigaray re-articulates female specificity also allow her to refigure the earth as active matter that “turns upon herself ” in generative flux. In the second section, I will situate Irigaray's re-thinking of matter in relation to Bennett's “vital materiality”.44Bennett can be aligned with a number of thinkers who have come to be grouped under the heading “new materialisms”. See S. Alaimo and S. Hekman, eds., Material Feminisms, Bloomington & Indianapolis: Indiana University Press, 2008; D. Coole and S. Frost, eds., New Materialisms: Ontology, Agency, and Politics, Durham and London: Duke University Press, 2010. View all notes An advantage of this concept is that it refuses the separation between humans and matter still implicit in concepts such as “the environment”. By attending to “our own constitution as vital materiality”, as well as the ways our “own” bodies are never “fully or exclusively human”, Bennett adjusts the status of human actants while re-evaluating non-human bodies “as actants rather than as objects”. As I will show, her approach provides a constructive critical perspective on Irigaray's work by drawing attention to the specifically non-sexuate nature of the elemental. Equally, however, Irigaray's insistence on sexuate difference problematises any appeal to a generic notion of “the human”. This is especially helpful, I will suggest, in relation to contemporary descriptions of climate change as “anthropogenic”. By homogenising human beings, such descriptions make it more difficult to address the ways in which current ecological problems are inseparable from global patterns of social, political and economic inequity. For both thinkers, challenging hylomorphism needs to be matched with a critique of the dominant modern model of the subject as bounded, autonomous and self-identical. And for both, this model is displaced and undone by the capacity of the human body to bear others within, in ways that engender and sustain human life. Yet as I will discuss in the final two sections, each thinker renders this “other within” in very different ways, with significant implications for the ethics and politics of a “vital materiality”. In the end it is Irigaray's rendering of a distinctively female capacity to bear an other within, explored via the generative relationality of a placental economy, that more fully escapes the individualism of the One and the Same. Together, Irigaray and Bennett show that to take seriously the ecological crises that currently confront us means overcoming the disavowal of both human beings' own fundamental materiality and our dependency on the sustaining materialities of the earth. In contrast, a dominant strand in contemporary responses to these crises is an environmental politics of “enlightened self-interest”55I borrow this phrase from H. Kopnina's critical discussion in “Forsaking Nature? Contesting ‘Biodiversity’ Through Competing Discourses of Sustainability”, Journal of Education for Sustainable Development 7, no. 1 : 51–63. that precludes any serious re-evaluation of human beings' relations to matter and the earth. If human beings can be persuaded that current levels of environmental degradation are damaging to them, threatening perhaps their very survival, they are more likely to take decisive steps to alter their behaviour. Insofar as such approaches demand action only for the sake of human interests and ends, they are both anthropocentric and spring from the same instrumentalising rationality that has engendered the ecological crises we currently face. They may well be successful in prompting action. But by foregrounding the survival of “the human species” per se, such approaches foreclose discussion of whose interests are served if survival is all that is allowed to be at stake, and whose lives are thereby consigned to ongoing exploitation. Moreover, as I will argue below, the instrumental rationality that serves survival is at odds with an affirmation of life, as a becoming that depends on difference. With this in mind, I will problematise Bennett's proposed politics of “expanded self-interest”, while seeking to retain many of the insights her approach brings. To more fully displace the “rational” self-interest that has encouraged human exploitation of the earth, we might take up Bennett's “vital materiality” in ways informed by Irigaray's conception of generative difference and the relational space-time of the in-between. (shrink)

Here in the Achilleid Statius catalogues the contributions of Greek towns to Agamemnon's expedition against Troy. Every item of equipment is appropriate to its origin. There is one puzzle, however: why is it that murorum tormenta are the peculiar contribution of Pylos and Messene? O. A. W. Dilke suggests that the proximity of classical Messene to Mt Ithome would have reminded Statius of the siege of that place by the Spartans in 464–59 b.c., when they were aided by the Athenians, (...) experts in siege warfare. This solution is undoubtedly ingenious but, based as it is upon association, it places this last entry in a quite different category from the previous entries: all the preceding items have been very definite products of their places of origin. K. von Barth , while noting the not unparalleled anachronism, attempts to account in another way for the siege-engines: ‘quia ibi silvae crassissimas arbores habent’. But there is no evidence to support this: Messenia features neither in the pages of Theophrastus or Pliny as a source of quality timber, nor in the poets as an area which is characterised by the stoutness of its trees. These theories pay insufficient attention to the verb tendunt, the vox propria for exerting a strain on rope, making it taut. (shrink)

The following views were presented at the Annual Meeting of the American Association for the Advancement of Science Seminar “Teaching Ethics in Science and Engineering”, 10–11 February 1993 organized by Stephanie J. Bird , Penny J. Gilmer and Terrell W. Bynum . Opragen Publications thanks the AAAS, seminar organizers and authors for permission to publish extracts from the conference. The opinions expressed are those of the authors and do not reflect the opinions of AAAS or its Board of Directors.

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)

Abortion: The morality of abortion, by P. Ramsey. The problem of abortion and the doctrine of double effect, by P. Foot. Whatever the consequences, by J. Bennett.--Sex: Sexual perversion, by T. Nagel. On sexual morality, by S. Ruddick.--Human rights and civil disobedience: Rights, human rights, and racial discrimination, by R. Wasserstrom. The justification of civil disobedience, by J. Rawls. Law and civil disobedience, by R. M. Dworkin.--Criminal punishment: The responsibility of criminals, by W. Kneale. Murder and the principles of punishment, (...) England and the United States, by H. L. A. Hart. Or else, by J. R. Lucas.--Violence and pacifism: What violence is, by N. Garver. Pacifism, a philosophical analysis, by J. Narveson.--War: War and murder, by G. E. M. Anscombe. On the morality of war, a preliminary inquiry, by R. Wasserstrom. Peace, by R. M. Hare.--Suicide and death: Suicide, by R. F. Holland. Death, by T. Nagel. Death, by M. Mothersill.--Bibliography (p. 386-390). (shrink)

Sex: Nagel, T. Sexual perversion. Ruddick, S. On sexual morality.--Abortion: Ramsey, P. The morality of abortion. Foot, P. The problem of abortion and the doctrine of the double effect. Wertheimer, R. Understanding the abortion argument. Thomson, J. J. A defense of abortion.--Prejudice and discrimination: Wasserstrom, R. Rights, human rights, and racial discrimination. Roszak, B. Women's liberation. Lucas, J. R. Because you are a woman. Thomson, J. J. Preferential hiring. Singer, P. Animal liberation.--Civil disobedience: Rawls, J. The justification of civil disobedience. (...) Singer, P. Rawls on civil disobedience. Dworkin, R. M. Law and civil disobedience.--Punishment: Downie, R. S. The justification of punishment. Kneale, W. The responsibility of criminals. Hart, H. L. A. Murder and the principles of punishment: England and the United States.--War: Anscombe, G. E. M. War and murder. Wasserstrom, R. On the morality of war: a preliminary inquiry. Lackey, D. Ethics and nuclear deterrence. Narveson, J. Pacifism: a philosophical analysis.--Suicide and death: Brandt, R. B. The morality and rationality of suicide. Holland, R. F. Suicide. Nagel, T. Death. Williams, B. The Makropulos case: reflections on the tedium of immortality.--Selected bibliography (p. 432-437). (shrink)